• Ignacio Sáez de la Fuente, Adrián Marcos Morales, Reyes Muñoz Calahorro, Elena Álvaro Valiente, María Sánchez-Bayton Griffith, Silvia Chacón Alves, Zaira Molina Collado, González de AledoAmanda LesmesALDepartment of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain., Isaías Martín Badía, González FernándezMaríaMDepartment of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain., Lidia Orejón García, Primitivo Arribas López, Susana Temprano Vázquez, and José Ángel Sánchez Izquierdo Riera.
• Department of Critical Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain Ignacio.saez@salud.madrid.org.
• Respir Care. 2024 Jun 28; 69 (7): 806818806-818.

BackgroundProne position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19.MethodsThis was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (∼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28.ResultsWe enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02).ConclusionsAmong subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care.Copyright © 2024 by Daedalus Enterprises.

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